DEPARTMENT OF HEALTH AND HUMAN SERVICES Form Approved
Administration for Children and Families OMB No.
Office of Child Support Enforcement Expires:

CHILD SUPPORT ENFORCEMENT ANNUAL DATA REPORT

STATE: SUBMISSION:

NEW

REVISED

FISCAL YEAR

ITEMS

(a)
TOTAL

(b)
CURRENT
ASSISTANCE

(c)
FORMER
ASSISTANCE

(d)
NEVER
ASSISTANCE

SECTION A: CASE INVENTORY

1. Cases Open at the End of the Fiscal Year

a. Interstate Cases Initiated in This State

b. Interstate Cases Received From Another State

c. Medicaid Only Cases

2. Cases Open at the End of the Fiscal Year With Support

a. Interstate Cases Initiated in This State

b. Interstate Cases Received From Another State

c. Cases With Orders for Zero Cash Support

d. Medicaid Only Cases With Orders

3. Cases Open at the End of the Fiscal Year

SECTION B: PATERNITY ESTABLISHMENT

4. Number of Children in Cases Open

5. Children in IV-D Cases Open at the End of the Fiscal Year

6. Children in IV-D Cases Open During or at the End of the
Fiscal Year With Paternity Established

7. Children in the IV-D Cases at the End of the Fiscal Year
With Paternity Resolved

8. Children in the State Born Out-of-Wedlock
During The Fiscal Year

9. Children in the State With Paternity Established
or Acknowledged During The Fiscal Year (Optional)

10. Children in the State With Paternity Acknowledged
During The Fiscal Year

SECTION C: SERVICES REQUIRED

11. Cases Open at the End of the Fiscal Year
Requiring Location Services

12. Cases Open at the End of the Fiscal Year
Requiring Services to Establish an Order

13. Children Requiring Paternity Determination Services
in Cases Open at the End of the Fiscal Year

SECTION D: SERVICES PROVIDED

14. Title IV-A Cases Closed During the Fiscal Year Where a
Child Support Payment Was Received

15. Cases Receiving Successful Location Services
During the Fiscal Year

16. Children in the IV-D Caseload for Whom Paternity
Was Established or Acknowledged During the Fiscal Year

17. Cases With Orders Established During the Fiscal Year

18. Cases With Collections During the Fiscal Year

a. Interstate Cases Initiated in Another State
With Collections During the Fiscal Year

19. Cases Sent to Another State During the Fiscal Year

20. Cases Received From Another State
During the Fiscal Year

SECTION E: MEDICAL SUPPORT

21. Cases Open at the End of the Fiscal Year
Where Medical Support is Ordered

22. Cases Open at the End of the Fiscal Year
Where Health Insurance is Ordered

23. Cases Open at the End of the Fiscal Year
Where Health Insurance is Provided as Ordered

SECTION F: COLLECTIONS DUE AND DISTRIBUTED

24. Total Amount of Current Support Due
for the Fiscal Year

$

$

$

25. Total Amount of Support Distributed as Current Support
During the Fiscal Year

$

$

$

26. Total Amount of Arrearages Due for All Fiscal Years

$

$

$

27. Total Amount of Support Distributed as Arrears
During the Fiscal Year

$

$

$

28. Cases With Arrears Due During the Fiscal Year

29. Cases Paying Toward Arrearages
During the Fiscal Year

SECTION G: STAFF

30. Full-time Equivalent Employees of State and Local
IV-D Offices on the Last Working Day in the Fiscal Year

31. Full-time Equivalent Employees Under Cooperative
Agreements on the Last Working Day in the Fiscal Year

32. Full-time Equivalent Employees of Privatized
IV-D Offices on the Last Working Day in the Fiscal Year

SECTION H: PROGRAM EXPENDITURES

33. Amount of Expenditures to Establish Paternities
During the Fiscal Year

$

34. Amount of Expenditures to Locate Non-custodial Parents
During the Fiscal Year

$

35. Amount of Expenditures to Establish Support Orders
During the Fiscal Year

$

36. Amount of Expenditures to Enforce Support Orders
During the Fiscal Year

$

37. Amount of Expenditures to Distribute Collections
During the Fiscal Year

$

SECTION I: NONCOOPERATION AND GOOD CAUSE

38. Cases at the End of the Fiscal Year in Which There
is a Determination of Noncooperation

39. Cases Open During the Fiscal Year With Good Cause
Determinations

SECTION J: ADMINISTRATIVE ENFORCEMENT

40. Administrative Enforcement Requests Received From
Another State During the Fiscal Year

41. Administrative Enforcement Cases With a Collection
During the Fiscal Year

42. Amount of Support Collected on Administrative
Enforcement Cases During the Fiscal Year

$

Paperwork Act Notice: State agencies are required to provide the information requested to receive a grant award under the provision of Title IV, Part D (Sections 452 and 469) of the Social Security Act (42 USC 652 and 669). This is public information and is published in an Annual Report to Congress. The responses to this collection are mandatory. This information is not considered confidential, therefore, no additional safeguards are considered necessary beyond that customarily applied to routine government information.

Reporting Burden Notice: Public reporting burden for this collection of information is estimated to average 4 hours per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding either thins burden estimate or other aspect of this request for information to: the Administration for Children and Families, Office of Child Support Enforcement, 360 L146Enfant Promenade, S.W., Washington, DC 20447 and to the Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.

This is to certify the information provided on this report is accurate to the best of my knowledge and belief.